POS0864 EFFECTIVENESS OF ANTIFIBROTICS IN RHEUMATOID ARTHRITIS-INTERSTITIAL LUNG DISEASE. NATIONAL MULTICENTER STUDY OF 50 PATIENTS IN CLINICAL PRACTICE
Authors: B. Atienza-Mateo, A. Serrano-Combarro, M. Martin Lopez, S. Castañeda, R. Melero, J. Loarce-Martos, N. Mena-Vázquez, M. D. C. Carrasco Cubero, C. Díez, D. Castro-Corredor, T. Vazquez Rodriguez, A. García-Valle, G. Bonilla, M. Rodriguez Lopez, D. Ferrer, R. Blanco
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Interstitial lung disease (ILD) is a severe complication of rheumatoid arthritis (RA). Abatacept and rituximab are the preferred disease-modifying antirheumatic drugs (DMARDs) for RA-ILD <b>[1-4]</b>. However, progression of ILD despite its use is not uncommon. A subgroup analysis of the INBUILD trial has shown a slower decline in forced vital capacity (FVC) in patients with progressive fibrosing autoimmune disease-related ILDs with the antifibrotic nintedanib (NINTE) <b>[5]</b>. <h3>Objectives</h3> <b>A</b>) To assess the efficacy of antifibrotic drugs, NINTE and pirfenidone (PIRFE), in Spanish RA-ILD patients with a progressive phenotype in clinical practice. <b>B</b>) To compare the profile of clinical practice RA-ILD patients with the RA-ILD patients included in the INBUILD trial <b>[5]</b>. <h3>Methods</h3> National multicenter study of RA-ILD patients to whom NINTE or PIRFE were added due to progressive fibrosing ILD. Demographic and clinical variables were collected from all patients. These features were compared with those of RA-ILD patients included in the INBUILD trial (n=89, 42 treated with NINTE and 47 with placebo). Forced vital capacity (FVC) evolution was the primary endpoint. Results are expressed as percentage, mean±SD or median [IQR]. <h3>Results</h3> A total of 50 patients (19 women/31 men) from clinical practice were collected (NINTE=45, PIRFE=5), mean age 70±8 years. Median ILD duration up to antifibrotic initiation was of 45 [19-72] months. Mean FVC one year before antifibrotic start was 81±20 (% pred.), whilst mean baseline FVC was 72±23 (% pred.). Comparison of baseline characteristics of RA-ILD patients treated with NINTE in clinical practice (n=45) and RA-ILD patients of the INBUILD trial is shown in <b>Table 1</b>. The evolution of FVC and DLCO in our patients from the previous year of antifibrotic initiation is shown in <b>Figure 1.</b> After a median follow-up of 16 [5-24] months, no decline in mean FVC and DLCO values was observed. Stabilization or improvement of dyspnea was found in 83% of patients. NINTE was withdrawn in 8 patients due to: gastrointestinal adverse events (GAE) (n=6), death (n=1) or hemorrhage risk (n=1). PIRFE was withdrawn in 2 patients due to GAE. <h3>Conclusion</h3> Antifibrotics, specially NINTE, seem to slow ILD progression in patients with RA-ILD. In clinical practice, patients are treated later in the evolution of the disease, but results are satisfactory. Combination of antifibrotics and DMARDs in RA-ILD is possible and safe. <h3>References</h3> [1]<i>Autoimmun Rev.</i> 2021 Jun;20(6):102830 [2]<i>Rheumatology.</i> 2020 Dec 1;59(12):3906-3916 [3]<i>Rheumatology.</i> 2021 Dec 24;61(1):299-308 [4]<i>J Clin Med.</i> 2020 Sep 23;9(10):3070 [5]<i>Arthritis Rheumatol.</i> 2022 Jun;74(6):1039-1047 <b>Members of the Spanish Collaborative Group of Antifibrotics in RA-ILD:</b> Juan Ramón de Dios (HU Araba), Libe Ibarrola (HU de Navarra), Carmen Gonzalez Montagut (HCU de Valladolid), Sergi Ordoñez (H. Arnau de Vilanova), Anahy Mª Brandy (HU Cabueñes), Fernando Lozano (HCD Gómez Ulla), Maria López Lasanta (HU Vall d'Hebron), Cristina Campos (CHGU de València), Marta Garijo (H. de Sagunto), Ivette Casafont (HU Germans Trias i Pujol), Mónica Calderón (H. José Molina Orosa), Carlota Iñiguez (HU Lucus Augusti), Francisco Ortiz-Sanjuán (HUP La Fe), Emilio Giner (H. Royo Villanova), Ignacio Braña (HU Central de Asturias). <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Belén Atienza-Mateo: None declared, Ana Serrano-Combarro: None declared, MARIA MARTIN LOPEZ: None declared, Santos Castañeda: None declared, Rafael Melero: None declared, Jesús Loarce-Martos: None declared, Natalia Mena-Vázquez: None declared, Maria del Carmen Carrasco Cubero: None declared, Carolina Díez: None declared, David Castro-Corredor: None declared, Tomas Vazquez Rodriguez: None declared, Andrea García-Valle: None declared, Gemma Bonilla: None declared, Marina Rodriguez Lopez: None declared, Diego Ferrer: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, lilly, Bristol-Myers, Janssen, Galapagos and MSD, Consultant of: bbvie, Pfizer, Roche, lilly, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD, novartis and Roche.